An article published in The American Journal of Nursing stated that dehydration – a fluid imbalance caused by too little fluid taken in or too much fluid lost or both, can occur quickly in all older adults and can generate harmful effects. Dehydration is becoming more prevalent—hospitalizations for dehydration in older adults increased by 40% from 1990 to 2000.

However, in many cases, dehydration is avoidable.

• In older adults, adequate fluid consumption has been associated with fewer falls, lower rates of constipation and lower rates of laxative use, as well as better rehabilitation outcomes in orthopedic patients and reduced risk of bladder cancer in men.
• Drinking five or more 8-oz. glasses of water per day has been associated with lower rates of fatal coronary heart disease in middle-aged and older adults
• Meanwhile, drinking 16 oz. of roomtemperature water before a meal cansignificantly lower the rates of postprandial orthostatic hypotension in older adults who had autonomic failure.
• Potential consequences of dehydration include constipation, falls, medication toxicity, urinarytract and respiratory infections, delirium, renal failure, seizure, electrolyte imbalance, hyperthermia and longer time to wound healing – especially pressure ulcers.
• In older adults with many comorbidities, dehydration can precipitate emergencyhospitalization and increase the risk of repeated hospitalizations.
• Most significantly, dehydration has been associated with increased mortality rates among hospitalized older adults.
• Causes of dehydration include diarrhea, excessive sweating, blood loss, fluid accumulation, inadequate fluid intake and fever.
• Illnesses that entail excessive urination, such as diabetes and hypercalcemia, may also increase the risk for dehydration.

Cognitive impairment has been associated with dehydration in older adults.

Dementia

Many people in early stages of dementia are undiagnosed. Because people with dementia often forget to drink, their actual intake should be assessed. Nursing interventions include prompts to drink water at regular intervals to ensure an adequate intake.

Delirium

Assessing the ability to drink is difficult in a patient with fluctuating cognitive abilities. Because delirium is usually transitory, the nurse may have to provide fluids until it subsides. Because delirium is often a symptom of an underlying condition such as infection, adequate hydration is important. Furthermore, dehydration can be a cause of delirium.

Concomitant conditions

Dehydration occurs more frequently in older adults who are frail and in those with diabetes, cancer, cardiac disease or acute infections – such as urinary tract infections, upper respiratory infections, pneumonia, gastroenteritis or skin infections. In addition, having multiple comorbidities has been associated with dehydration.

Nursing implications:

• Older adults should not consume large amounts of fluid at one time. Some older adults may have diminished renal function, which may result in overhydration.
• It is essential that frail elderly patients with multiple comorbidities and several limitations in the ability to perform activities of daily living drink small amounts consistently throughout the day.
• Calculating a fluid goal in hospitalized patients can help nurses to monitor fluid intake before difficulties arise.
• The most effective standard to be followed is – 100 mL/kg for the first 10 kg of weight, 50 mL/kg for the next 10 kg of weight, and 15 mL/kg for the remaining weight.Thisoption was considered “reasonable for patients whether they are of normal weight, underweight, or overweight.”
• Except those who may require fluid restrictions to prevent overhydration—those with severe congestive heart failure, renal failureor certain severe mental disorders in which polydipsia is a feature, most older adults should have a fluid goal of at least 1,500 mL per day.
• Careful monitoring is required for symptoms that suggest congestive heart failure—for example, new weight gain, pedal edema, neck vein distension or shortness of breath.
• Finding the right amount an older adult should drink per day can be difficult, but it’s important.

Fluid Preferences:

• It has been found that fluid intake increased in nursing home residents who were given the beverages they requested.
• Although water is often considered the best beverage, substitutions may include fruit juices, low-sodium soups, decaffeinated coffee and tea and water-rich fruits – watermelon, berries, grapes, peachesand vegetables – tomatoes, lettuce and summer squash.
• For those who request fluids that are not considered healthful – such as caffeinated coffee or carbonated drinks, occasional indulgence may be allowed. Drink temperature is also important, and preferences may vary.

Source: The American Journal of Nursing. 2006 Jun;106(6):40-9; quiz 50. doi: 10.1097/00000446-200606000-00023.